Muscle Relaxants For Back Pain

To Treat or To Forcibly Relax - That Is The Question...

In This Article –

  • Types of Muscle Relaxants
  • Pros and Cons of Using Muscle Relaxants for Back Pain

What Are Muscle Relaxants Designed To Achieve?

Muscle relaxants for back pain are designed to treat muscle spasm and can be highly successful because they actually decrease muscle tone without reducing muscle strength. You might wonder why this is important, but if you suffer with muscle spasms, pain or hyperreflexia, then softening the muscle tone and tightness can be just the solution.

Muscle Relaxants can basically be divided in to two main groups –

  1. Neuromuscular blockers. These work on the neuromuscular junction. They are used mostly during surgery to create short-term flacid paralysis of muscles or if they need to insert some type of tube in to the your body, such as a ventilation tube in to the trachea (throat).
  2. Spasmolytics. These aim to reduce muscle spasms are by far the most common type of muscle relaxants for back pain. They work centrally at the level of the spinal cord or the brain.

What Is A Muscle Spasm?

Before we go any further however, it is worth clarifying in real terms, what a muscle spasm is and why it is so closely associated with back pain.

A muscle spasm is basically a contraction of the muscle that is neither voluntary or controllable. It is also sometimes referred to as muscle cramp. When someone overworks their back muscles and suddenly pulls up in pain or twists round to pick something up and arches up in agony, that is actually an ‘acute muscle spasm’.

The action is question has caused the muscle to spasm suddenly and the result is severe pain lasting anything from a few seconds to many minutes. It is not a ‘twitch’ and will most certainly not be felt in the same way by the person suffering.

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Causes of Lower Back Spasms

Back spasms are most commonly the result of heavy lifting or strenuous activity causing injury to the muscles around the lower back from activities such as golf or rugby.

‘Spasmolytics’ are then prescribed by a doctor specifically to treat one of two main problems –

  1. To reduce muscle spasms following overexertion/ injury
  2. To manage severe muscle disorders such as cerebral palsy or multiple sclerosis

The chemical equation for diazepam - a major muscle relaxant

There are numerous muscle relaxants for back pain available to target different receptors. We wont go in to more detail than this, otherwise we’ll get lost in the world of GABA agonists and so forth – except to add that these spasmolytics/ muscle relaxants can be broken down in to two main groups –

  1. Drugs for Acute Muscular Spasm (cyclobenzaprine, methocarbamol or orphenadrine). These act on the brain stem producing a sedative effect to combat back pain typically arising from muscle injury. They and are not effective on muscle spasms from cerebral palsy or direct spinal cord injury.
  2. Drugs for Chronic Muscle Spasm (Diazepam, Baclofen, Tizanidine, Dantrolene, Botulinum Toxin and Gabapentin). These act on the muscle cell itself or the central nervous system in the spinal cord. Chronic Muscle Spasm is loosely defined as back pain/ spasm that has been regularly occurring over a period of time. At this point, it is vital to establish the cause of the chronic muscle spasm, before creating a full treatment plan.

Both work by treating what is known as ‘muscle spasticity’ – that is a repeating arc of spasm and pain running from skeletal muscle to the spinal cord and back. This can be started by muscle damage or CNS motor neurone dysfunction. The goal of ‘spasmotytic therapy’ (muscle relaxants) as mentioned previously is to reduce the muscle tone without reducing the muscle strength.

How Fast Do Muscle Relaxants for Back Pain Actually Work?

The time for a muscle relaxant to work varies depending on the drug in question – but many can take affect within 30 minutes

Negative Effects of Muscle Relaxants?

Common Side effects – Drowsiness, dizziness, dry mouth, urinary retention, fatigue, weakness, addiction, acid reflux.

They are highly addictive and a commonly abused substance. The trouble is they can help with such extreme pain that people easily become hooked on them. When abused they can cause heart failure and paralysis.

The problem is that the muscle relaxants for back pain can be so fast acting and effective, that patients very quickly become dependent on them as their only form of pain relief. When being asked to stop taking them or try a different treatment, they will experience all the withdrawal effects of trying to give up an addiction.

Some MRs even carry anti-depressant properties when broken down in the liver, which can further someone’s dependence on them.

Most muscle relaxants carry a warning not to drive or operate heavy machinery after use and that is why it’s normally advised to only take them before going to bed (unless they are administered by direct injection of course)

For these reasons, muscle relaxants are very often only offered for a limited period of weeks (often 2-3wks) and their prescription is closely monitored.

The Final Word –

Beyond any doubt, muscle relaxants have a place in modern medicine. Whether they are ideal for your really depends on you reason for needing them and your lifestyle outside of your back pain.

If you have a history of addiction (even mild addiction), then the risks are much higher and will soon outweigh the benefits. Similarly, if you drive for a living, then one of the many non-drowsy alternatives may be a better option. 

However, if your pain is either likely to be temporary (following an injury) or so severe that working with machinery is out of the question anyway, then muscle relaxants are certainly a good option as their pain control is excellent.

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